RISK-FACTORS FOR ENTEROCOCCAL URINARY-TRACT INFECTION AND COLONIZATION IN A REHABILITATION FACILITY

Background: We attempted to define the risk factors for urinary tract acquisition of enterococcus in a 155-bed rehabilitation facility in So utheastern Michigan by performing a prospective, case-controlled obser vational study. Methods: All cases were identified from daily review o f microbiologic records of urine culture results. All urinary isolates of enterococcus species, whether representing infection or colonizati on, were saved on agar plates for subsequent pulsed-field gel electrop horesis. Thirty-five percent of urinary tract isolates were due to ent erococcal species compared with 5% to 15% in adjacent acute-care facil ities. A control was defined as the next patient with a nonenterococca l urinary isolate. Results: No differences were found between cases an d controls with respect to age, sex, admitting diagnosis, voiding habi ts, symptoms, laboratory values, geographic location, caregivers, or u rinary infection versus colonization. Conclusions: Prior antibiotic us e was more frequent in the patients colonized or infected with enteroc occal isolates (78% vs 41%). No evidence was found for a single clone of enterococcal isolates in our facility by DNA analysis, suggesting t hat the acquisition of enterococcus in the urinary tract was endogenou s.